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AB2026-11-003 Pharmacy updates
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 31, 2026
Summary
Capital Blue Cross administrative bulletin 2026-11-003, dated November 1, 2026, updates its Advantage and Value Plus, CHIP, Elite and Exclusive, and Value formularies and pharmacy utilization management programs, with an effective date of January 1, 2027 unless otherwise indicated. The changes include an expanded list of drugs requiring prior authorization, new and modified quantity level limits, new and modified step therapy requirements, and drugs removed from formulary. A footnote states that one change is effective October 1, 2026, and that existing users will have a PA to grandfather them until 10/1.
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What to do
by Jan 1, 2027 · 4 steps
01The billing team should check the formulary and Pharmacy Utilization Management details at CapitalBlueCross.com, because the expanded prior authorization list, the new and modified quantity level limits and step therapy requirements, and the removed drugs all take effect on that date.
02The new prior authorization additions include EDARBI, GLASSIA and MICARDIS HCT.
03Impacted members will be notified prior to the change.
04Already effective October 1, 2026: a footnote states that this change is effective that date, with existing users grandfathered under a PA until 10/1, so check its current applicability.
Original notice
AB2026-11-003 Pharmacy updates
capbluecross.com · Always check the source before changing claims.